Controlled Substances

Opioids

For more information, see pain control

Benzodiazepines

General information

• Include benzodiazepine receptor agonists, e.g. zolpidem (Ambien), zaleplon (Sonata), eszopiclone (Lunesta)

• Effectively treat generalized/social anxiety, panic disorder, sleep disorders when prescribed at low doses for a short period of time (< 30 days)

  • Choosing wisely: Don’t use benzodiazepines or other sedative-hypnotics in older adults as first choice for insomnia, agitation, or delirium

• Increase in prescriptions and long-term continuation among primary care physicians is potentially concerning

Risks

• May worsen PTSD symptoms

• Risks while driving: Same as BAC between 0.050% and 0.079%

• Increase risk for hip fractures by 1.5 to 2.55 times

• Long term use: Substantial cognitive decline that did not resolve 3 months after discontinuation

• Beers criteria

  • May be appropriate for seizure disorders, rapid eye movement sleep disorders, benzodiazepine withdrawal, ethanol withdrawal, severe generalized anxiety disorder, periprocedural anesthesia, end-of-life care

  • Avoid benzodiazepines (any type) for treatment of insomnia, agitation, or delirium due to increase risk of cognitive impairment, delirium, falls, fractures, and motor vehicle accidents (SOR Strong)

  • Benzodiazepine-receptor agonists

    • Adverse events are similar to those of benzodiazepines in older adults

    • Avoid chronic use, i.e. > 90 days (SOR Strong)

Agents with Primary Care Prescribing Suggestions

Use

• Anxiety: Benzodiazepines are NOT first line (SSRIs, SNRIs are)

• Insomnia: Effect diminishes after a few weeks

• Seizure disorder: Should be managed by neurology

Start taper for any patient taking daily benzodiazepines for > 1 month, especially:

• Age > 65 years

• If also taking opioids or amphetamines

• In patients with history of a substance abuse, cognitive disorder, and/or TBI

Codes

• Code A - Panic Disorder

• Code B - Behavior/Attention Deficit

• Code C - Chronic Debilitation/Neurological Disorder/Seizures etc

• Code D - Chronic pain/Incurable

• Code E - Narcolepsy

• Code F - Hormone Deficiency/Metastatic Breast Cancer